anytriptiline: my 12 year journey with amitriptyline / Elavil

[anytriptaline]

So here I am, I've gotten some good information from the site before but mostly remained a lurker, right now I think I need a little bit of support from people that truly understand what I've been through

 

While this journey starts in 2007 I have to clarify that it wasn't my first time dealing with ADs. Much younger, in 2001 I was hooked up on Zyprexa for what I feel was an irresponsible reaction to something that required another set of actions (heavy bullying, and I'll leave it at that). That experience made me very weary of the effects of antidepressants and how fast medical personnel relies on them. Thankfully I got off them (mostly) fine

 

So let's fast forward to 2007

 

I was getting very preoccupied by a girl thing during that period and had no one to talk to. I decided, sure, why not? and went to a psychologist. I got to say it was a very pleasant experience and overall it helped a lot

 

But then this happened. I've always had trouble with insomnia since I was a kid. Out of nowhere I had a whole night episode of insomnia. It was like something popped in my head and the feeling of sleepiness was removed. I had never pulled an all-nighter before. It coincided with a trip to the psychologist

 

He over-panicked and took me to the psychiatrist office, saying that wasn't normal and he prescribed me two meds: Amitriptyline, 25mg and Perphenazine 10mg. I really wish to know what would have happened if I had, you know, just tried to sleep normally that night again

 

In short, those pills felt like magic, they were like sleep on a pill, for someone with sleep issues all his life it was very tempting to continue using them. Sure, they made me sleepy in the morning, but nothing a cup of coffee couldn't solve

 

A couple of years later I had to change doctors again, the new doctor prescribed me with bipolar II and added 500mg of valproic acid, sometimes more. I have no idea how he reached that conclusion since valproic acid felt like a placebo to me

 

Over the years the side effects started to get more noticeable, specially after my doctor made a mistake and gave me 4mg pills of perphenazie instead of 10mg. I pointed this out but he told me it was "impossible" to put me on 10mg again since I would get more sedated. To him, my insomnia was caused by bipolarity and everything working was the perphenazine and valproic acid. For some reason he claimed that amitriptyline was only making me drowzy in the morning. He tried to remove it completely and playing with varying degrees of the other drugs. But I was already working by that time, my job requires me to have a good mental performance. So I never tried any of his variations or new drugs for more than 2 days of zero sleep

 

The last two years

 

The side effects ended up being unbearable. Before that I had bad days sprinkled here and there, from now one I graded the days by how bad they were. I had depersonalization, lost the train of thought, got extremely dizzy, physically and mentally tired all the time, this made my job unbearable. On top of that I started to develop serious bladder and gastrointestinal problems, both urologists and gastros I visited not only agreed that the drugs were the culprit, they pushed me to start questioning what was going on. My doctors (and really all doctors after that) are very prone to minimize side effects or downright deny them and give the most useless advice (change your coffees for something stronger like a redbull)

 

With this doctor I tried to quit the meds completely with what was a fairly "normal" taper of a quarter of a pill every two weeks. Side effects continued and insomnia got worst until I lost the ability to sleep when I went off them completely. Lasted 4 days until I got back to them (job responsibilities couldn't wait). He told me to not take the valproic acid becausee "maybe it's not bipolarity". His las try was using midazolam but it didn't work

 

November last year

 

Reached a breaking point and quit my job, there was no way I was going to be able to fix this and work at the same time. My plan was to do a slow taper and see how it went. Sadly, I ended up listening to some family members that took me to "two of the best doctors in the region".

 

From november to february I took, in really short periods of time: quetiapine, mirtazapine, pregabaline, estazolam, agomelatine, levomepromazine, trazodone, sulpiride. They either didn't work at all or gave me way worst side effects

 

The last doctor was particularly bad, not only did he denied I had insomnia and returned to "everything is just bipolarity" but he also gave me diazepam, it didn't made me sleep and he only gave me amitriptyline again until I begged him I need to start sleeping again. I told him I didn't want diazepam, I knew the risks, I had reacted terribly to benzos before, but he insisted in exchange of the amitriptyline, and told me it was "a soft med, I give it to old people".

 

Anyway, after a month he took me cold turkey off the diazepam and for 2 months I had the worst withdrawal symptoms I felt in my life. He insisted it was all in my head. I had to convince my family to take me to another shrink I personally researched who obviously said I was suffering from benzo withdrawal and in his opinion "nothing in my medical history sounds like bipolarity"

 

He gave me the same meds (amitriptyline and perphenazine) and have been "stable" the last two months. "Stable" means feeling exactly how I was feeling in November with the exception that the gastro issued haven't returned at full intensity again

 

So, next week, I restart work again, maybe it was a bad decision, but I haven't worked in 9 months, bills don't pay themselves and don't see an end in sight.

 

I see my doctor in August, I want him to agree to a 10% a month taper. He laughed about it saying it is "too conservative" and was petrified when I told him about dissolving the pills on liquid. I read about the scale method and plan to order one and hope he will agree to it

 

On top of that, I'm going to a CBT-i doctor. I have tried it before and can say it helps greatly with sleep, sadly, it does nothing for the side effects. I can say without a doubt my only problem is insomnia. The last few months, the short periods I've been off zero meds I have felt great, I can think again, my body feels right. Sadly, I can't sleep and it starts to take a toll around the 4th day. My record in January was a 9 day period of zero or close to zero sleep time, I expected that the brain would just shut down if I force it, but it didn't

 

So, any help would be appreciated, specially in the side effect department. I need to function normally in my job again. I've read about taking modafinil, huperzine or other cholinergic agonist to see if they might counteract the amitriptyline symptoms

[Gridley]

Welcome to SA, Anytriptiline.  Sorry you have been put through the mill by the doctors.  

 

I need some clarification about your side effects.  You wrote:

 

 

"The side effects ended up being unbearable. Before that I had bad days sprinkled here and there, from now one I graded the days by how bad they were. I had depersonalization, lost the train of thought, got extremely dizzy, physically and mentally tired all the time, this made my job unbearable. On top of that I started to develop serious bladder and gastrointestinal problems, both urologists and gastros I visited not only agreed that the drugs were the culprit,"

 

A few questions, please.  

 

What time period does this paragraph refer to?

 

The only drugs you were on when you were having the side effects in the paragraph above were Amitriptyline and Perphenazine, correct?

 

What time do you take the Amitriptyline and the Perphenazine?  

 

To which drug do you attribute the side effects? 

 

Are you still having these same side effects now with the exception of the gastrointestinal issues improving?

 

Are the side effects as bad now as they were in the paragraph above?

 

Why did the latest doctor put you on these two drugs?

 

What is your daily symptom pattern now? Do you feel better or worse in the hours after you take the Amitriptyline?  The Perphenazine?   Please keep daily notes on paper about your symptoms, when you take your drugs, and their dosages. Use a simple list format with time of day on the left and notation (symptom, drug and dosage) on the right.  Please also include the number of hours you're sleeping each night.  This is an example:

 

6 a.m. Woke with anxiety
8 a.m. Took 2.5mg Lexapro
10 a.m. Stomach is upset
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Feel a bit better
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Feeling dizzy
10:30 p.m. Fell asleep
2:30 a.m. Woke, took 3mg Ambien (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke but got back to sleep

 

Please post this daily for several days.  Once we've seen this and receive the answers to the questions above, we'll be in a better position to help you.

 

We recommend tapering no more than 10% of current dose every four weeks.  

 

Why taper by 10% of my dosage?

 

We recommend tapering only one drug at a time.  Otherwise, if problems arise you won't know which drug taper is responsible.  

We suggest tapering the more activating drug first, which we call accelerators, leaving the more sedating drug, wh9ch we call brakes, for later.  Both your drugs are brakes, so it will depend on your reaction to them as to which we recommend you taper first.

Taking multiple psych drugs? Which drug to taper first?

 

We are a site for going off drugs and can't make a recommendation regarding adding further drugs.

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Please research all supplements first and only add in one at a time and at a low dose in case you do experience problems.

 

Regarding the scale, many members use the AWS Gemini-20 scale, available on Amazon.  Does Amazon operate in Mexico?

 

Using a digital scale to measure doses

 

This is your Introduction topic, where you can ask questions, post updates and connect with other members.  We're glad you found your way here.

 

 

 

 

 

 

 

 

 

[anytriptaline]

Thanks for the reply Gridley!

 

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What time period does this paragraph refer to?

I would say 2015 to November 2018. It got specially worst around the summer of 2017 when I started developing the gastro symptoms. I'm pretty sure by themselves exacerbated my problems since every passing hour at work was a living nightmare. The gastro symptoms started to gradually become better after I got off the original meds in November. They came back in February after I was reintroduced to amitriptyline but not to the same degree, the bladder issues did though, I hadn't truly appreciated how abnormal they were until I got them back. I can't sleep a whole night uninterrupted due to them, during the nights I spent awake before being reintroduced again I barely used the bathroom

 

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The only drugs you were on when you were having the side effects in the paragraph above were Amitriptyline and Perphenazine, correct?

No, also Valproic acid 500mg. I think the doctor removed it completely in September that year. Didn't noticed a change. Valproic acid is truly the most bening drug I've used. I don't "feel it" if it is even doing something

 

 

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What time do you take the Amitriptyline and the Perphenazine?  

Usually at 7:30pm, whole dose. Over the years I have tried different times, but I like that one because I'm able to take it before dinner. Seems that if I take the meds with a meal they assimilate more slowly and don't kick in during the time I go to sleep.

The main problem is that, at this dose, I am pretty sedated by 9:30pm. I do some hobby work and right now I'm completely useless by that time. It started to get worse around a month ago, when I got reintroduced to them I was able to work until 11:00pm

In March, this new doctor told me to split the perphenazine half in the morning/half at night. Didn't noticed anything unusual but asked to take it again at night because I can sleep from 9 to 12 hours and sometimes I missed the morning time

 

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To which drug do you attribute the side effects? 

Amitriptyline. Over the years, there would be times I would stay awake until 4am puzzled why I wasn't sleeping only to find out I left the amitriptyline dose in the kitchen. My first long time doctor tried with variations of valproic acid and perphenazine alone but those never made me sleep.

I'm really afraid I might be developing early signs of dementia with the anticholinergic pathways of amitriptyline. Specially since my symptoms have appeared gradually over time

 

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Are you still having these same side effects now with the exception of the gastrointestinal issues improving?

 

Yes, in february they were more apparent to me since I had been 4 months without them. Things like losing the train of though or forgetting words weren't common during that time.

 

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Are the side effects as bad now as they were in the paragraph above?

 

Nowhere near as bad, but at the same time, I have been unemployed for 9 months. While I'm doing some "work" I set my own expectations and schedules. I don't drive if I don't feel ready. Those things will change once I resume working

 

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Why did the latest doctor put you on these two drugs?

Because, after the other doctors tried so many drugs, it was pretty clear we weren't going to find one that worked by luck. He said I needed to be stable first, and as bad as these are, they make me "stable". Some of the other drugs I was given destroyed me completely, I was supposed to do some remote work during that time but one of the drugs (don't remember which) made me forget how to even type my passwords

 

Our best bet could be nortriptyline. But they don't sell it as a standalone drug in my country and I wasn't feeling confident in trying new things

 

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What is your daily symptom pattern now? Do you feel better or worse in the hours after you take the Amitriptyline?  The Perphenazine?   Please keep daily notes on paper about your symptoms, when you take your drugs, and their dosages. Use a simple list format with time of day on the left and notation (symptom, drug and dosage) on the right.  Please also include the number of hours you're sleeping each night.  This is an example:

 

I'll do it, I keep a sleep diary and did something similar with the CBT doctor at the beginning of therapy. Will be interesting considering what I'm about to get into next week.

 

These days is, extremely sedated a couple of hours after taking them. Sedated, confused during the day, with short periods of time when I'm "OK", but my "OK" expectations are really low

 

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Regarding the scale, many members use the AWS Gemini-20 scale, available on Amazon.  Does Amazon operate in Mexico?

Yup, there's even the import option for that one which is nice. I also live near the border and believe it or not there is a shopping culture in the Northeastern states, so even buying supplements in south Texas is not a problem. The last hack doctor I went even told me it would be a good idea to look for nortriptyline in South Texas

[Gridley]

1 hour ago, anytriptaline said:

 

 I'm really afraid I might be developing early signs of dementia with the anticholinergic pathways of amitriptyline.

 

Thank you for answering my questions.

 

Since the side effects are coming from the Amitriptyline, and since you are concerned about the possibility of dementia, it  seems the best course would be to taper it first and leave the Perphenazine to taper after you finish the Amitriptyline taper.  One good thing is that side effects generally lessen as the dose lessens.

 

Once you get your scale, are you ready to start tapering?  I gather from your last post that you're feeling relatively stable.  Work may be a stressor to take into account, and you'll need to monitor how you're feeling.  A 10% taper is definitely not too conservative.  Depending on how you feel, you may need to taper more slowly or add in hold weeks.  The Brassmonkey slide taper, which I'm using for my Lexapro taper, divides the 10% monthly taper into four equal weekly 2 1/2% cuts followed by a two-week hold.

 

The Brassmonkey Slide Method of Micro-tapering

 

Please post your daily symptom notes here in your Introduction topic.

 

 

 

 

[anytriptaline]

I'll wait until my doc visit in August to start tapering. I just want to have the official assurance he would try to help me.

 

I'm even thinking about buying one of those analytical balances to be completely sure. They are expensive, but money is not a problem and I've already spent a lot on my issues.

 

The Brassmonkey method sounds perfect, even more "conservative"

[ChessieCat]

Many of the members here, including BrassMonkey, find the Gemini 20 scale suitable.  BrassMonkey managed to measure low doses and only had to weigh and divide manually the last very tiny doses.

[anytriptaline]

I think it all comes down to how much the pill weights. I read that the repeteability is around 3mg. For 25mg that's unacceptable, but I know the pill obviously weights more than that because of the filling. How much does it weight? I guess I'll wait to find out

[Gridley]

 

11 hours ago, anytriptaline said:

I think it all comes down to how much the pill weights.

 

According to Brassmonkey, the Gemini scale was accurate only to 4mg pill weight.  After that he had to start visually dividing the powder to get the smaller doses.

[anytriptaline]

So first day

 

Total bed time:10h 30m, total sleep time: 8h 40m. Took me more than an hour to sleep, woke up around 5 times (very usual due to my bladder issues). I had been sleeping very fast lately, however, Friday night I took 1 1/4 of a pill instead of the usual 1 1/2 I was taking and took me 3 hours to get sleep, that's the reason why I opened the thread yesterday, hope to get back to normal soon. I'll probably get back to work on tuesday/wednesday, so tomorrow is probably my last day with few responsibilities

• 8am. Spent some time reading the internet. Sleepy, depersonalized. 
• 10am. Took the car to buy some things and get something to eat. Dizzy, confused, depersonalized
• 11am. Went to my parents home, mostly stayed on bed, gradually I started to feel better, just a little tired
• 6pm. Did some weight training. I suffered from stomach flu during the week. Just did some light lifting. 
• 7pm. Started to get really sleepy
• 8:30pm, took the meds, I'm starting to feel really sedated (9:30)

Not a good day, but it's infinitely easy when you got nothing to do. Just some notes

I know staying in bed is bad, but I only do it on sundays because my parents house doesn't have any place to get AC and it's really hot this time of the year. I avoid it all week and avoided it during the winter-spring. As you see, I felt very well in bed. I don't know why, it just does, I have told doctors about it but they just brush it off. Over the years that was my way to get through the day, I skipped lunch from work some times and just laid in bed until I started to feel fine and went back to work

I do weight training regularly and have done it for almost 10 years but it doesn't work. I get bouts of extreme tiredness and lose strength suddenly. I went to a pro coach years ago and after a few months just told me she had no idea what was going on and I was the weirdest case she ever witnessed. Never told her about the pills. I have asked over the internet before and people seem to agree I will never be able to gain any strength until I quit the pills. I continue doing it because it helps with the weight gain, otherwise I balloon up. Been doing cardio in the mornings too, but that's probably going to be next to impossible soon

 

I didn't do weight training during the period I wasn't taking the pills, I quit lifting in the fall 2018 because I was so frustrated about it and resumed it in March when I was on the pills again

[Gridley]

12 hours ago, anytriptaline said:

I took 1 1/4 of a pill instead of the usual 1 1/2

 

What pill is that?

[anytriptaline]

10 minutes ago, Gridley said:

 

What pill is that?

amitriptyline

[Gridley]

22 minutes ago, anytriptaline said:

33 minutes ago, Gridley said:

 

amitriptyline

 

It's important to take the same dose every day.  The central nervous system craves consistency.

The rule of 3KIS: Keep it simple. Keep it slow. Keep it stable.

[anytriptaline]

Yes, I was desperate because I've been pretty sedated lately and I'm scared to go back to work like this, but I guess I learned my lesson

[ChessieCat]

On 7/14/2019 at 11:37 PM, Gridley said:

 

 

According to Brassmonkey, the Gemini scale was accurate only to 4mg pill weight.  After that he had to start visually dividing the powder to get the smaller doses.

 

using-a-digital-scale-to-measure-doses

 

Found this response to another member regarding this:

 

On 7/15/2019 at 5:15 AM, brassmonkey said:

The gemini 20  is good down to 4mgpw (0.004) below that it has trouble with accuracy.  So you have several more cuts that can be directly weighed on the scale.  After that I found it easiest to weigh out the 4mgpw and visually divide it into quarters and work from there.  Not as accurate, but gets the job done.

 

[anytriptaline]

Total bed time: 9h 30m, sleep time 8h 30m, 89.47% eficciency. It took me like 30-40 minutes to sleep. I'm getting there

 

8am. Dizziness, tired

9am. Worked at the computer, some improvement.

11am. Went to the bank, kinda dizzy, disoriented

2pm. Working, dizziness and confusion got worse

3pm. Kinda calm, watched some tutorials while I was downloading something work related

4pm. Got worse again.

7pm. Read some work thing, got extemely dizzy

8pm. Pills start to work, very confused

9:30pm Pretty sedated

 

I return to work on Wednesday. I'm dreading it, there is no way I'm going to survive it

 

Scale should arrive on thursday

[ChessieCat]

23 minutes ago, anytriptaline said:

I return to work on Wednesday. I'm dreading it, there is no way I'm going to survive it

 

Part of getting through this is learning to rephrase things.  Instead of saying "there is no way I'm going to survive it" it would be better to say "I know it might be difficult but I will try my best to get through it".

[anytriptaline]

Total bed time: 9h 10m, total sleep time: 8h 20m. Slept better, only woke up two times and took me like 20 minutes to sleep

 

9am. Worked on the computer. Tired, dizzy. But thinkig mostly clear

11am. No important changes. Went to the bank to fix some issues

1pm. clumsy, but no real brain fog

4pm. Went to parrent's house, no real change

9pm. Pretty sedated.

 

I felt "better" today, but more clumsy in general, like things were being done on automatic

 

Received my balance, Amazos Mexico had it on stock and delivered super fast. Both pill hover a little over 200mg, and that's great. Got the same measurments time after time, so I'm liking the balance. I still need to weight more pills to get the average, but I have plenty of time until my visit to the shrink

 

Going back to work tomorrow, I will need to wake up very early for my liking. I'm already dreading it, will share the experience tomorrow

[anytriptaline]

Total bed time: 8h 30m, total sleep time: 7h 40m, 90.2% efficiency 

 

This wasn't a good day, it could ended way worse

 

Finally got back to work, pretty sedated all day. I got the fun news that the usual work times incresead, used to be 9am to 6:30. Now it's 8am to 6:30, but of course no one leaves at 6:30, I left the office at almost 7:30 today. We get a "free afternoon" on fridays. Of course that's not completely true

 

7:30 am. Started the day fine, but then got dizzy and confused.

8:30 am. Arrived to the main headquarters. Very tired, confused

11 am. Arrived at the new offices, not much change

12pm. Heavy tiredness started to kick in

1pm. Ate, got more tired

4pm. Maybe a little less tired

5pm. Felt tiredness started to improve.

7pm. Tiredness and confusion kick in just in time to leave.

8pm. Took my pills, usually did it at 7:30, I guess that's a thing of the past

9:30pm. Tried to work on personal projects but I got too sedated.

 

I can't see how I'm going to survive like this, thank god I told them this was just an experiment, I'm already throwing the towel

[Altostrata]

I am confused. Why do you think amitriptyline rather than perphenazine is causing your most unpleasant symptoms? See side effects at https://www.drugs.com/sfx/perphenazine-side-effects.html

 

The combination of amitriptyline and perphenazine is marketed as its own tablet, see side effects at https://www.drugs.com/sfx/amitriptyline-perphenazine-side-effects.html

 

To me, this is a scary drug combination and the side effects you experience are almost disabling. Very gradual tapering, much more gradual than a quarter of a tablet at a time, can help you avoid withdrawal insomnia.

 

Why are you waiting to taper?

[anytriptaline]

To be honest, I don't know. I do know that amitriptyline is the thing that unequivocally puts me to sleep, so I got to assume it's also the thing that causes me side effects, but I don't deny that perphenazine might contribute too. As I said, when I was "accidentally" changed dose from 10mg to 4mg it was the time I felt the side effects started to become unbearable, but it might have been a coincidence, who knows.

 

When I went to the "second best doctor in the region" he only put me on amitriptyline after I begged him for something to sleep, my current doctor removed everything he gave me but reintroduced me to perphenazine to become "stable" after I got the bad diazepam withdrawals

 

I'm waiting to taper until my next appointment, I've known how doctors react when you make changes behind their backs, I expect my experience with this doctor to be a drug dealer/junkie kinda of thing but I don't want to look for a new dealer so soon. I have an appointment on August 3rd, I might start the taper on August 1st because it's a Thursday and if something goes wrong, two days of no sleep on workdays are not so bad

[anytriptaline]

Better day, altought I hate to refer them as "better"

 

Last night I was very sedated, almost tripped, I cried because I hadn't felt this tired in a while. My sleep got disturbed around 5am, stayed like 40 minutes awake, but extremely dizzy

 

Total Bed time: 8h 30m, sleep time: 7h, efficiency: 82.35%

 

The first part of the day was horrible. I was really scared to take the car to go for lunch. I know it's wrong but I laid on my bed at my parent's house and that gave me a lot of energies for the rest of the day. The CBT doctor is going to be pissed off, but that's my only relief

 

8 am: Woke up tired, imrpoved with coffe.

9am: Not so tired, brain fog, a little dizz

11am: Tiredness starts to set in

12:30pm: Very dizzy, very nervous, probably because of so much coffee

2:30pm Came back to work, improved with bed rest

4pm: A little tired but an improvement from the morning

6:45pm: More tiredness starts to set in

7:30pm: Left job, drive wasn't too bad

9:40pm:Heavy sedation starts to set in

 

I'm going to buy 00 capsule and fill them once I start the tapering, I guess it is the best solution

 

 

 

[anytriptaline]

On average, better work day than the last ones, though everything started to fall apart after going home. I was also pissed off that "leaving early" was a lie. In total I work like 2 hour more daily than I did before quitting

 

8am. Not so tired, a little brain fog

10am. Felt "OK"

11am. Started to get dizzy and tired

2pm. Very dizzy

3pm. Felt a little dizzy, I think that the last coffe woke me more

6pm. Very dizzy

7pm. Very dizzy, depersonalization

9pm. Pretty sedated, very dizzy, trouble thinking, huge depersonalization. Very nervous, blame it on so much coffee during day

 

I'm ready to call it quits, if I get asked at work how I feel, I'll tell them to get a replacement, I might last 3 more months and that's it, the schedule is too gruesome for me at the time. Func fact, since I started I've lost two rare remote jobs due to being unavailable 

 

In other news, I bought some empty capsule to use in the taper. And I'm seriously considering building a chainmail blanket as a weighted blanket alternative (can't use one, sweat like a pig at night)

 

I have an appointment with the CBT doctor tomorrow, I'm dreading to hear I should think positive and the side effects will go away

 

[anytriptaline]

Total Bed time: 8h 50m, total sleep: 8h, 90.57% efficiency

 

Today was a better day at least

 

In general, morning was bad but things started to improve around 12pm, was quite busy working on my personal projects

 

Went to the CBT doctor, was better than I was expecting

 

Made some measurings with the scale but I think I'm posting that on the tapering forum

 

Tomorrow is rest day

 

 

[anytriptaline]

Haven't written in the last two days, I'm just beyond exhausted by 9:00 pm

 

Yesterday I had a nervous breakdown at night because I was too tired to do some house chores. I told my boss to please look for a replacement, we are going to talk about my situation today.

 

I'm very sleepy and with a little depersonalization at the moment. Took 100mg of modafinil when I woke up but it doesn't seem to work, even with two cups of coffee. I'm terrified I'm going to run over someone on my way to work, but taking a taxi means waking up even earlier and losing the chance of resting on my lunch break

[Altostrata]

Please incorporate when you take your drugs and their dosages into your daily notes.

 

As you've been "stable" -- meaning predictable side effect pattern -- why are you waiting to taper off perphenazine? It is a very risky drug.

 

It's likely perphenazine is contributing to, if not causing, your fatigue and other symptoms. It look like you feel a bit better mid-day when it wears off.

 

See https://www.drugs.com/ppa/perphenazine.html

 

I find this part remarkable:

Quote

Discontinuation of therapy: American Psychiatric Association (APA), Canadian Psychiatric Association (CPA), and World Federation of Societies of Biological Psychiatry (WFSBP) guidelines recommend gradually tapering antipsychotics to avoid withdrawal symptoms and minimize the risk of relapse (APA [Lehman 2004]; Cerovecki 2013; CPA [Addington 2005]; WFSBP [Hasan 2012]); risk for withdrawal symptoms may be highest with highly anti-cholinergic or dopaminergic antipsychotics (Cerovecki 2013). When stopping antipsychotic therapy in patients with schizophrenia, the CPA guidelines recommend a gradual taper over 6 to 24 months, and the APA guidelines recommend reducing the dose by 10% each month (APA [Lehman 2004]; CPA [Addington 2005]). Continuing anti-parkinsonism agents for a brief period after discontinuation may prevent withdrawal symptoms (Cerovecki 2013). ....

 

You may be able to get it compounded into a liquid for tapering, or you can mix it with water for a do-it-yourself suspension (the injectible form is made with water (pdf)). These topisc explains how to make your own liquid and taper with an oral syringe.

How to make a liquid from tablets or capsules
 
Pharmacy liquids to make suspensions

 

Questions and answers about liquid medications

 

Using an oral syringe and other tapering techniques

 

If I were you, I'd start with 2mg tablets and take your dose in one 2mg tablet plus 2mg in liquid form per day, then slowly reduce the liquid.

 

[anytriptaline]

I honestly don't think it is the perphenazine (from what I understand I take a very tiny dose)

 

When I went to the "second best doctor in the region" and he reintroduced me to amitriptyline (not perphenazine), I started to sleep again but my symptoms returned. After I got the bad diazepam withdrawal this new doctor reintroduced me to perphenazine to "become stable" with the same things I was taking before they got interrupted in November. He even had me take half the dose in the mornings and didn't noticed any more sedation. I wish I had never returned to it, but I had no other option

 

Years ago, my old doctor tried to get me to sleep with perphenazine alone and it didn't work. To me, it seems like a very benign drug at this dose

[anytriptaline]

Yesterday was terrible, I think I only felt "not so bad" for two hours in the afternoon

 

I made a lot of mistakes driving, I'll not drive again until I feel comfortable again, it's a matter of time before I run someone over. This will make things extremely difficult, since I laid on the back of the car when I was feeling particularly bad. Also, my workplace is in a very rough part of town, with no restaurants in close distance, so I will have to survive with trash from the vending machine since there are no refrigerators to bring food

 

I went to sleep at 9:30 pm hoping to get some rest, it took me like 30 minutes to sleep but I woke up at 3:40 am and couldn't get back to sleep, probably due to stress, modafinil and the six cups of coffee I drank yesterday

 

I was preparing to go to work but then I felt extremely dizzy, I'm terrified to leave my room

 

I'm just waiting for the inevitable phone call. I think I'll need to talk to my CBT doctor, I told her I didn't felt ready but she pushed me to take my job back, I knew I should have listened to my instincts

[anytriptaline]

Yesterday wasn't good but at least I stayed at home and it made it really bearable, I only had to drink coffee in the morning , when I felt bad I just laid a few minutes on the couch and then went to the computer to work remotely

 

I strangely felt very well around 7pm, but I had to take my pills around that time and by 9pm they started to hit hard

 

Today I came to work, I don't want to drive so tired anymore so I picked an Uber, I lost my keys but thank god the driver found them and hopefully will return them before the day is over, that's just an example of how sedated I am.

 

No one has mentioned a word about yesterday and it pisses me off. I've already drank 3 coffees and I'm falling asleep and I'm extremely dizzy, really wondering if I should drink another one before lunch

[anytriptaline]

Didn't wrote the last few days, I feel it'll get too repetitive

 

I survived last week, weekend was OK but I felt I didn't slept enough, I can't get the 12+ hours of sleep I was getting on weekends before November

 

Today I made the mistake of taking the car to work as I was getting late. I was too sedated on the road

 

I sent a message to the shrink as I'm getting desperate. He suggests adding biperiden to wake up. So, another drug. I hope to start the amitriptyline tapering next week so I don't know how detrimental this might be

 

The thing is that, I can't keep an office job this way, and the tapering will last years, I need relief from these side effects fast. Or maybe I should bit the bullet, quit this job and hope to find something remote to work in the future

[Gridley]

 

 

56 minutes ago, anytriptaline said:

He suggests adding biperiden

 

Anytriptaline, please be aware of these drug interactions between your current drugs and biperiden.

 

Gridley

 

Before using perphenazine, tell your doctor if you are also on biperiden. You may need dose adjustments or special tests in order to safely use both medications together. You should notify your doctor if you have signs of bladder problems, dry mouth, stomach pain, fever, blurred vision, confusion, dizziness, or reduced heart rate. You should avoid driving until you know how these medications will affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using your medications without first talking to your doctor first.

Switch to professional interaction data

Moderate

 

 

Moderate

 

 

Using amitriptyline together with biperiden may increase side effects such as drowsiness, blurred vision, dry mouth, heat intolerance, flushing, decreased sweating, difficulty urinating, abdominal cramping, constipation, irregular heartbeat, confusion, and memory problems. Side effects may be more likely to occur in the elderly or those with a debilitating condition. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch

[anytriptaline]

Yes, I read that 😕 weird, considering it's supposed to be an stimulant

 

Another option would be to change to other TCA, from my research it could be imipramine, but I haven't read good stories with it (including yours Gridley). Apparently nortriptyline is way gentler but it's not sold as an individual dose in Mexico, but as Motival, a mixture with fluphenazine, and I can't find many information about it. The "second best doctor in the region" believed nortriptyline could solve the sedation issues and let me sleep, but he refused to prescribe motival due to the fluphenazine

[Gridley]

27 minutes ago, anytriptaline said:

Another option would be to change to other TCA,

Seems like a taper would be a better option, if that's still what you want to do.  Side effects generally lessen as the dose is lowered.

[anytriptaline]

That's what I want to do. But after doing a regular 2 month taper last year, I never felt the side effects lessened until I quit the drugs completely and I lost the ability to sleep. In fact, my sleep worsened and had to deal with the side effects on top of that

[anytriptaline]

So last week wasn't a good one, plus I bought an analytical scale and was informed it might never arrive, I got a complete refund so I hope it does, lol

 

I talked to my shrink. He wants to put me on Quetiapine and Escitalopram. I refused since I was prescribed quetiapine in November, barely slept and ended up in a clinic because I was feeling terribly, his reasoning for this to work this time is because he "is going to put me on more quetiapine this time". No thanks

 

However, he accepted for me to try nortriptilyne instead of amitriptyline. I know it's not going to be popular here but I want to try it, I've read it has a lower incidence of side effects and right now it's my only hope of a semi-normal life. I'm talking with someone that imports American meds and hope to get it by the end of the week

 

On other stuff, I started using huperzine A, 50mcg on friday and saturday and upped to 100mcg since sunday. I don't know if it's placebo but sunday and monday I felt "normal", tired but OK, could think clearly, didn't had a sedated feeling all day. I didn't slept well on sunday and monday nights though, yesterday was fine but I also used melatonin

 

Next week I start my trial period. Half a day present at the office, half day remote. Hope something improves

[anytriptaline]

I started nortriptyline on thursday night, 25 mgs each day.

 

I would say I was feeling "better", but I wasn't sleeping well, and it was starting to catch on. Yesterday I took 50mgs on the doctor's suggestion and I slept like a log, but now I'm extremely tired and getting back the episodes of depersonalization, so maybe the improvement was just the smaller dose. I couldn't drive to work today for the afternoon

 

Wondering if I should continue with the experiment or just go back to amitriptyline and start the slow taper

[Gridley]

20 hours ago, anytriptaline said:

 

Wondering if I should continue with the experiment or just go back to amitriptyline and start the slow taper

 

It really depends on whether you want to be off the drugs or not.  Some people do, some don't.  It's a deeply personal decision that you''ll have to make for yourself.  

 

I'm not able to pick up the link but there's a SA thread, "Has anyone decided it was best to stay on meds indefinitely?"  Google 

"SurvivingAntidepressants.org has anyone decided it was best to stay on meds"  There's a lengthy discussion with many members giving their rationales, and it may help you with your decision

 

If you do decide to taper, you haven't been on the nortriptyline long, so you could just switch back to your previous dose of amitriptyline, hold until you stabilize from this latest drug switch, then taper according to the guidelines I've given you previous.